Fertility preservation in patients with haematological disorders: a retrospective cohort study

This study investigated the factors associated with utilization of fertility preservation and the differences in treatments and outcomes by prior chemotherapy exposure in patients with haematological diseases. This study included all 67 women with haematological diseases seen for fertility preservation consultation at two university hospitals between 2006 and 2011. Of the total, 49% had lymphoma, 33% had leukaemia, 7% had myelodysplastic syndrome and 4% had aplastic anaemia; 46% had prior chemotherapy; and 33% were planning for bone marrow transplantation, 33% pursued ovarian stimulation and 7% used ovarian tissue banking; and 48% of patients did not pursue fertility preservation treatment. All five cycle cancellations were in the post-chemotherapy group: three patients with leukaemia and two with lymphoma. Patients with prior chemotherapy had lower baseline antral follicle count (10 versus 22) and received more gonadotrophins to achieve similar peak oestradiol concentrations, with no difference in oocyte yield (10.5 versus 10) after adjustment for age. Embryo yield was similar between those who had prior chemotherapy and those who had not. Half of the patients with haematological diseases who present for fertility preservation have been exposed to chemotherapy. While ovarian reserve is likely impaired in this group, oocyte yield may be acceptable

Installing oncofertility programs for common cancers in optimum resource settings (Repro-Can-OPEN Study Part II): a committee opinion

The main objective of Repro-Can-OPEN Study Part 2 is to learn more about oncofertility practices in optimum resource settings to provide a roadmap to establish oncofertility best practice models. As an extrapolation for oncofertility best practice models in optimum resource settings, we surveyed 25 leading and well-resourced oncofertility centers and institutions from the USA, Europe, Australia, and Japan. The survey included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed three major characteristics of oncofertility practice in optimum resource settings: (1) strong utilization of sperm freezing, egg freezing, embryo freezing, ovarian tissue freezing, gonadal shielding, and fractionation of chemo- and radiotherapy; (2) promising utilization of GnRH analogs, oophoropexy, testicular tissue freezing, and oocyte in vitro maturation (IVM); and (3) rare utilization of neoadjuvant cytoprotective pharmacotherapy, artificial ovary, in vitro spermatogenesis, and stem cell reproductive technology as they are still in preclinical or early clinical research settings. Proper technical and ethical concerns should be considered when offering advanced and experimental oncofertility options to patients. Our Repro-Can-OPEN Study Part 2 proposed installing specific oncofertility programs for common cancers in optimum resource settings as an extrapolation for best practice models. This will provide efficient oncofertility edification and modeling to oncofertility teams and related healthcare providers around the globe and help them offer the best care possible to their patients

A View from the Past Into our Collective Future: The Oncofertility Consortium Vision Statement

Today, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium. The Oncofertility Consortium is an international, interdisciplinary initiative originally designed to explore the urgent unmet need associated with the reproductive future of cancer survivors. As the strategies for fertility management were invented, developed or applied, the individuals for who the program offered hope, similarly expanded. As a community of practice, Consortium participants share information in an open and rapid manner to addresses the complex health care and quality-of-life issues of cancer, transgender and other patients. To ensure that the organization remains contemporary to the needs of the community, the field designed a fully inclusive mechanism for strategic planning and here present the findings of this process. This interprofessional network of medical specialists, scientists, and scholars in the law, medical ethics, religious studies and other disciplines associated with human interventions, explore the relationships between health, disease, survivorship, treatment, gender and reproductive longevity. The goals are to continually integrate the best science in the service of the needs of patients and build a community of care that is ready for the challenges of the field in the future

Temporal refinement does not affect predicted human chorionic gonadotropin rise in early pregnancy

U današnje vrijeme poremećaji hranjenja sve su učestaliji, te u njih ubrajamo anoreksiju nervozu, bulimiju nervozu i neodređeni poremećaj hranjenja. Anoreksija nervoza je poremećaj jedenja opasan po život. Iako je u središtu bolesti hrana, anoreksija nervoza je zapravo psihijatrijska bolest. Češća je u žena, te u osoba koje se bave profesijama u kojima je društveni pritisak za biti mršav veoma jak (modeli, plesači). U pacijentovoj glavi stvara se iskrivljena slika o vlastitom izgledu, te sve više propadaju, kako fizički, tako i psihički. Postoje dokazi za biološke, psihološke i sociokulturne čimbenike rizika bolesti, ali točan uzrok poremećaja prehrane je nepoznat. Bolesnici koji pate od anoreksije nervoze odbijaju priznati svoj problem, te na tuđu zabrinutost reagiraju ljutito ili obrambeno. U liječenju sudjeluje čitav niz liječnika i medicinskih sestara, te je najbitnije otkriti ,,središnji'' razlog straha od debljanja, započeti adekvatno liječenje, te vratiti pacijenta na normalnu tjelesnu težinu. Medicinske sestre imaju središnju ulogu u liječenju ove bolesti, budući da su one te koje provode najviše vremena s oboljelom osobom. Sve to doprinosi stvaranju povjerenja, pozitivne atmosfere, te je liječenje uspješnije.Today, eating disorders become more frequent and they include anorexia nervosa, bulimia nervosa and eating disorder, undefinite. Anorexia nervosa is a eating disorder dangerous to life. Although it is at the center od the disesase food, anorexia nervosa is actually a psychiatric disease. It is more frequent in women, and in those persons who deal with professions where is a strong social pressure to be skinny (models, dancers...). Inside of patient's head a disorted picture of their own appearance is created and that is why they are increasungly decaying both, mentally and physically. There is evidence for biological, psychological and sociocultural factors of the disesase, but the exact cause of the eating disorder is unknown. Patients suffering from anorexia nervosa refuse to acknowledge their problem, and others worry angrily or defensively. A whole team of doctors and nurses is involved in the treatment, and it is most common to discover the ''central'' reason for fear of being overweight, starting adequate treatment, and returing the patient to normal body weight. Nureses have a central role to play in treating this disease, since they are the ones who spend most time with the affected person. All this contributes to the creation of confidence, positive atmosphere and treatment more successfully

Patient attitudes and preferences for the management of pregnancy of unknown location

ObjectiveTo understand patient attitudes and preferences when faced with the uncertainty of pregnancy of unknown location (PUL).DesignQualitative, interview-based study.SettingUniversity Hosptial.PatientsPatients aged >18 years sampled from the emergency department and a subspecialty fertility practice of a university hospital system.InterventionsSix to 8 weeks after resolution of a PUL, with an ultimate clinical outcome of either an intrauterine pregnancy, spontaneous abortion, or ectopic pregnancy. Participants underwent either surgical, medical, or expectant management.Main outcome measuresThematic analysis of the virtual, semistructured interviews (45-60 minutes in length) conducted with participants to identify commonly expressed priorities was performed.ResultsInterviews were completed from October 2020 to March 2021 until thematic saturation was achieved (n = 15). Resolution diagnoses included intrauterine pregnancy (26.7%, n = 4), ectopic pregnancy (40.0%, (n = 6), and spontaneous abortion (33.3%, n = 5). Moreover, 66.7% (n = 10) of the patients presented to the emergency department, whereas 33.3% (n = 5) presented to a subspecialty fertility clinic. All had desired pregnancies. Thematic analyses revealed 4 related priorities around PUL management: health of pregnancy; health of self; future fertility; and diagnostic prediction and diagnostic certainty. The relative balance of these priorities was dynamic and evolved throughout the course of management with different outcomes. A second set of themes related to logistical preferences included mental health support, clarity of treatment and next steps, and continuity of care. Interrater reliability was validated with a pooled κ of >0.8. Limitations include that all participants had desired pregnancies, and the experiences of those who experienced different pregnancy outcomes may have been affected by recall bias.ConclusionsThese data demonstrate novel themes around related priorities in patients with desired pregnancies diagnosed with a PUL previously underappreciated by clinicians. The balance of these priorities evolved throughout management with increasing information and clarity. Continually reevaluating relevant patient priorities and preferences is essential to the comprehensive management of PUL

Fertility preservation in patients with haematological disorders: a retrospective cohort study

This study investigated the factors associated with utilization of fertility preservation and the differences in treatments and outcomes by prior chemotherapy exposure in patients with haematological diseases. This study included all 67 women with haematological diseases seen for fertility preservation consultation at two university hospitals between 2006 and 2011. Of the total, 49% had lymphoma, 33% had leukaemia, 7% had myelodysplastic syndrome and 4% had aplastic anaemia; 46% had prior chemotherapy; and 33% were planning for bone marrow transplantation, 33% pursued ovarian stimulation and 7% used ovarian tissue banking; and 48% of patients did not pursue fertility preservation treatment. All five cycle cancellations were in the post-chemotherapy group: three patients with leukaemia and two with lymphoma. Patients with prior chemotherapy had lower baseline antral follicle count (10 versus 22) and received more gonadotrophins to achieve similar peak oestradiol concentrations, with no difference in oocyte yield (10.5 versus 10) after adjustment for age. Embryo yield was similar between those who had prior chemotherapy and those who had not. Half of the patients with haematological diseases who present for fertility preservation have been exposed to chemotherapy. While ovarian reserve is likely impaired in this group, oocyte yield may be acceptable